Can You Bill 2 Two Units of 90837?
As experts in medical billing and coding. We know that sometimes complex billing and coding can feel overwhelming, especially when dealing with psychotherapy services. Accurate billing not only ensures compliance but also helps maximize reimbursement, allowing you to focus on excellent patient care.
Billing for psychotherapy sessions can get tricky, especially when it comes to determining if 90837 can be billed more than once in a single day.
In this blog, we’ll answer this key question while diving into essential billing nuances like therapy minutes units, CPT code 90834 definition, and rules for billing extended time CPT code services.
What Are CPT Codes And Why Are They So Essential For Medical Billing
Ever wondered what makes medical billing possible? Current Procedural Terminology (CPT) codes are the standardized language that healthcare providers use to describe services and procedures. They ensure accuracy when billing insurance companies and tracking healthcare data.
For psychotherapy, codes like 90837, 90834, and 99354 CPT code 2023 are vital for ensuring providers are properly reimbursed.
While this blog focuses on CPT codes related to psychotherapy, understanding the broader spectrum of CPT codes is crucial for effective billing. For insights into urgent care CPT codes and how they play a role in streamlining billing for different services, check out our blog on What Are the CPT Codes for Urgent Care?.
CPT Code 90834 Definition
The CPT code 90834 definition specifies its use for a 45-minute psychotherapy session. This code is commonly used for slightly shorter therapy sessions compared to CPT code 90837, making it vital for practitioners offering varied session lengths.
Can You Bill Two Units of 90837?
Yes, two units of 90837 can be billed in a single day, however there are few conditions to it, if you meet the following criteria you are good to go;
- It’s important that you should have two separate sessions that last for at least 60 minutes.
- Each session must meet the criteria for billing 90837, including a minimum of 53 minutes of direct patient contact and appropriate documentation.
- You must bill each unit separately on your claim form.
Important to note:
Billing multiple units of 90837 in a single day is not common and may be subject to scrutiny by insurance payers. Ensure your claims are both accurate and ethical. When in doubt, consult with your insurance company or a billing expert.
Relevant CPT Codes for Psychotherapy Services
Here are some commonly used CPT codes:
- CPT code 90834: This code is for individual psychotherapy sessions that should last at least 45 minutes.
- CPT code 90836: This code is also used in individual psychotherapy sessions, however it requires additional 30 minutes.
- CPT code 90839: This CPT code is used in psychotherapy for crisis services and procedures. The sessions should last between 30–74 minutes.
- CPT code 90840: This code is used for family psychotherapy, the sessions last between 30–74 minutes.
- CPT code 90847: This code is also used for family psychotherapy, and the session time should be 45 minutes at least.
How Long Does a Therapy Session Need to Be to Bill 90837?
The CPT code for 90-minute psychotherapy isn’t 90837. Instead, 90837 is designated for individual psychotherapy sessions that exceed 53 minutes. If the session is extended beyond the usual timeframe, additional services like 99354 CPT code 2023 or 99417 may apply under specific scenarios.
Billing for Extended Sessions
Previously, there were separate CPT codes for prolonged services, those include codes 99354 and 99355. However, these codes were deleted in 2023. A new code was introduced, 99417, this can be used to bill for prolonged services, however, it cannot be used with psychotherapy codes 90837 or 90847.
For sessions exceeding the typical timeframe but not reaching the extended service criteria, add-on codes exist. We’ve discussed such add-on codes in our previous blogs. If you want to explore the rules and nuances of billing CPT code 90785 and 90837 together, to explore our detailed guide click here. This blog provides in-depth insights into how to accurately bill these codes and avoid common pitfalls.
How Long Between Sessions Can I Bill Initial Again?
The ability to bill an “initial” session again depends on various factors like insurance policies and treatment progress. The question how long between sessions can I bill initial again usually arises when a new treatment plan or diagnostic evaluation is being introduced. Most payers require a significant gap between “initial” sessions to justify the billing.
The Overlap Between Therapy and Family Psychotherapy
One common question among providers is: Can you bill 90837 and 90847 on the same day? The answer depends on payer-specific guidelines. While both involve direct patient care, most insurers won’t allow these codes to be billed together for the same patient on the same day. Clarifying this with your payer can save time and prevent rejections.
In Conclusion
While you can bill two units of 90837 in a single day under specific circumstances, careful documentation and adherence to ethical guidelines are crucial. For further questions or queries you must consult your insurance provider or expert professionals of medical billing and coding.
Need help navigating complex billing codes like 99354 CPT code 2023 or understanding 90837 CPT code reimbursement? Hubur Enterprises LLC is here to support you! Visit our coding page or contact us today for expert assistance.
Frequently Asked Questions about Psychotherapy Billing and CPT Codes
Can two 30-minute therapy sessions be billed on the same day?
No, it is not possible to bill two 30-minute therapy sessions on the same day using CPT code 90837. The code is only applicable when the session is for 53 minutes or more.
How is a unit different from a session in CPT codes?
In CPT coding, a unit typically refers to a set amount of time or a specific service provided. In the case of CPT code 90837, a single unit of this code demonstrates a psychotherapy session that is for at least 53 minutes.
What is the purpose of CPT code 99417?
CPT code 99417 is used to report prolonged services, such as extended outpatient or office visits. However, CPT codes 90837 and 90847 (psychotherapy codes) can not be billed together.
Can I bill a psychotherapy session that lasts 90 minutes?
Yes, a 90-minute session can be billed by combining codes. You would bill one unit of CPT code 90837 for the first 53+ minutes and an additional unit of CPT code 90836 for the remaining time.
How much is the out-of-pocket cost for CPT code 90834?
The out-of-pocket cost for CPT code 90834 varies depending on your healthcare provider and insurance plan. It’s best to contact your insurance company for detailed information on coverage and costs.
Can I bill CPT code 99417 and CPT code 99215 together?
No, you cannot bill CPT code 99417 with CPT code 99215, as these codes are designed for different services and are not meant to be used together.
Is CPT code 99355 still in use?
No, CPT code 99355 was retired in 2023 and is no longer valid for billing purposes.
Which CPT code is used for a maze procedure?
There isn’t a specific CPT code designated solely for a maze procedure. The correct coding depends on the individual steps and techniques involved in the procedure.
